EP1865862B1 - Vis pédiculaire - Google Patents

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Publication number
EP1865862B1
EP1865862B1 EP06724014.3A EP06724014A EP1865862B1 EP 1865862 B1 EP1865862 B1 EP 1865862B1 EP 06724014 A EP06724014 A EP 06724014A EP 1865862 B1 EP1865862 B1 EP 1865862B1
Authority
EP
European Patent Office
Prior art keywords
shaft
accordance
region
pedicle screw
relief zone
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP06724014.3A
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German (de)
English (en)
Other versions
EP1865862A1 (fr
Inventor
Simon Casutt
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Zimmer GmbH
Original Assignee
Zimmer GmbH
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Filing date
Publication date
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Priority to EP06724014.3A priority Critical patent/EP1865862B1/fr
Publication of EP1865862A1 publication Critical patent/EP1865862A1/fr
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Publication of EP1865862B1 publication Critical patent/EP1865862B1/fr
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8625—Shanks, i.e. parts contacting bone tissue
    • A61B17/863—Shanks, i.e. parts contacting bone tissue with thread interrupted or changing its form along shank, other than constant taper
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7004—Longitudinal elements, e.g. rods with a cross-section which varies along its length
    • A61B17/7008—Longitudinal elements, e.g. rods with a cross-section which varies along its length with parts of, or attached to, the longitudinal elements, bearing against an outside of the screw or hook heads, e.g. nuts on threaded rods
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/70—Spinal positioners or stabilisers, e.g. stabilisers comprising fluid filler in an implant
    • A61B17/7001—Screws or hooks combined with longitudinal elements which do not contact vertebrae
    • A61B17/7002—Longitudinal elements, e.g. rods
    • A61B17/7019—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other
    • A61B17/7031—Longitudinal elements having flexible parts, or parts connected together, such that after implantation the elements can move relative to each other made wholly or partly of flexible material
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/864—Pins or screws or threaded wires; nuts therefor hollow, e.g. with socket or cannulated
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/56—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor
    • A61B17/58—Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws or setting implements
    • A61B17/68—Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/84—Fasteners therefor or fasteners being internal fixation devices
    • A61B17/86—Pins or screws or threaded wires; nuts therefor
    • A61B17/8685—Pins or screws or threaded wires; nuts therefor comprising multiple separate parts

Definitions

  • the invention relates to a pedicle screw comprising a head for coupling with an elastic intervertebral stabilization or support system, and a shaft for anchoring in a vertebra, which extends in the implanted state through the pedicle into the vertebral body.
  • the invention also relates to an intervertebral stabilization system with multiple pedicle screws.
  • the pedicle screws are also referred to below as "fasteners”.
  • Pedicle screws of this type and intervertebral stabilization and support systems are for example off US 2005/0154390 . US 5,492,442 . WO2005 / 065374 . WO03 / 032862 . EP 0 669 109 A1 . EP 0 672 388 . US 4,950,269 or EP 528 706 known.
  • Such screws have as a head a closed or unilaterally open eyelet, the latter form in certain embodiments tulip or tuning fork shape and the eyelet is provided to receive the intervertebral stabilization or support elements and to fix by suitable measures.
  • EP 0 669 109 A1 describes an elastic stabilization system and provided for pedicle screws of the aforementioned type and as indicated in the preamble of claim 1.
  • the known pedicle screws thus have a shaft for anchoring in a vertebra and a trained as eyelet head that can accommodate a band of the stabilization system.
  • a pedicle into which a screw is to be inserted can, in a simplified mechanical model, be regarded as a beam attached to the vertebral body, which can sag significantly under load.
  • the stiffness profile in the direction of the longitudinal axis of the pedicle is not constant. Rather, the stiffness in the area of the transition between pedicle and vertebral body compared to the adjacent areas is significantly increased.
  • a pivot point also referred to as a toggle point, forms around which the pedicle screw tilts under load.
  • This fulcrum is generally about more or less in the range of the transition between pedicle and vertebral body.
  • the tilting of the loaded pedicle screw leads to a high load on the cancellous bone of the vertebral body through the free end region and in particular through the tip of the pedicle screw. This results in heavy loads on the so-called bone interface, which under unfavorable circumstances, for example in the case of progressive osteoporosis, can result in screw loosening in the long term.
  • high stresses within the shaft are generated, above all, slightly anterior to the pivot point.
  • Pedicle screws are used in conjunction with both rigid and elastic intervertebral stabilization or fixation systems (stiffening or support systems).
  • intervertebral stabilization or fixation systems stiff or support systems
  • systems that provide a non-locking connection or coupling between the intervertebral support elements for example, between a pedicle screw attached to a caudal and a cranial vertebra
  • Provide bars or ribbons, on the one hand and the pedicle screws on the other hand, such as elastic, dynamically stabilizing systems are introduced essentially no moments, but virtually exclusively pure tensile / compressive forces in the screw head or recorded there. This has the consequence that the pedicle can bend.
  • the stiff screw thus experiences a kind of tilting stress, which due to the relatively low bending stiffness of the pedicle can not be supported by these and therefore introduces high forces in the cancellous bone of the vertebral body in the region of the screw tip on the so-called bone interface.
  • pedicle screw which has a flexurally elastic zone in a region lying more or less directly adjacent to the head and lying outside the bone after implantation.
  • a relief zone is provided which is located between an upper shaft region adjacent to the head and a lower shaft region, wherein the upper shaft region and the lower shaft region have a higher flexural rigidity than the relief zone.
  • the pedicle screw is suitable, inter alia, for use in intervertebral stiffening or support systems which provide a non-angularly stable connection between the intervertebral support elements, for example, between a pedicle screw attached to a caudal and pedicle screw attached to a cranial vertebra, and the pedicle screws.
  • a system of this kind is also indicated and claimed.
  • the screw specified here can also develop highly advantageous effects in other support or stiffening systems or other applications.
  • the stem is provided with a relief zone having a reduced flexural rigidity against an upper stem region adjacent the head, the relief zone being located in the region of the stem for placement in the bone.
  • the shaft of the fastener (pedicle screw) is provided with a relief zone, which can also be referred to as a flexible transition zone.
  • a relief zone which can also be referred to as a flexible transition zone.
  • the course can be set arbitrarily in principle by the design of the relief zone and in particular adapted to the characteristic properties of the vortex. It has been found that by the relief zone, the transmission of bending moments, which are caused by acting on the head of the fastener forces can be limited in the free end region of the fastener.
  • the shank of the fastener may, under load due to the relief zone, effectively sag in unison with the bone structure into which the fastener is implanted. High loads on the bone material and high stresses in the shaft are thereby avoided.
  • the adaptation of the bending stiffness of the pedicle screw to the biological conditions thus creates a further improved safety for the patient.
  • a plurality of pedicle screws anchorable to the vertebrae and a connecting device for connecting at least two pedicle screws anchored to adjacent vertebrae to an elastic stiffening or support system are provided.
  • Conventional pedicle screws often have a conical shape and, strictly speaking, no constant bending stiffness over the length of the shaft. However, such a "bending stiffness profile" does not have a relief zone in the sense given here. Rather, the pedicle screw specified here is based on the idea of deliberately reducing the bending stiffness of the shaft in a specific axial region.
  • Pedicle screws are usually implanted in the area of the lumbar vertebrae L1 to L5. Although these vertebrae are not identical in the same patient or in different patients, all vertebrae of interest for the implantation of pedicle screws are consistent with certain characteristics, as mentioned above. This circumstance, which will be discussed in more detail below, can be used in the pedicle screw specified here by the bending stiffness profile of the shaft is specifically adapted to the bone structure formed by pedicle and vertebral body. However, the pedicle screw specified here is not limited to the lumbar vertebrae mentioned. In particular, an application for the thoracic vertebrae is possible in principle.
  • the flexural stiffness of the relief zone is substantially equal to or slightly above that of a pedicle.
  • the bending stiffness is, for example, 1.5 to 4 times, 1.5 to 3 times, 2 to 4 times or 2 to 3 times the flexural rigidity of Pedicle, this value is to be selected depending on the overall geometry of the screw so that in particular in the area of the screw tip surface pressure of the cancellous bone sets below the maximum allowable surface pressure, but taking into account a safety factor as good as possible utilization of the permissible Load allowed.
  • the head can be rigidly coupled to the upper shaft region at least in the bending direction of the shaft and in particular be in one piece.
  • the coupling is fixed with respect to a bend, but torsion is possible.
  • the gradient of the bending stiffness at the transition from the upper shaft region to the relief zone may be greater in magnitude, in particular significantly greater, than a bending stiffness gradient occurring in the upper shaft region.
  • the amount of the gradient of the bending stiffness may be at least twice as large, in particular at least 5 times as great, and furthermore in particular at least 10 times as great as in the upper shaft region, at least in one region of the shaft.
  • the bending stiffness can be substantially reduced abruptly at the transition.
  • the bending stiffness in the relief zone can in at least one bending plane with respect to the flexural rigidity in the upper shaft region by at least 30%, in particular by at least 50%, in another Embodiment by at least 60%, and in yet another embodiment by at least 80% less.
  • the upper shaft region may be dimensioned such that the relief zone is located in the region of the shaft provided for placement in the spongiosa, while at least the region provided for placement in the cortical bone is formed by the upper shaft region.
  • the upper shaft region thus serves to support the solid bone material.
  • the length of the upper shaft area may be at least 5mm, in particular at least 8mm, and at the maximum 15mm, and especially at the maximum 12mm.
  • the flexural rigidity or the maximum permissible surface pressure in the vertebra has a characteristic course that is basically the same for all vertebrae, based on an axis passing through the pedicle and the vertebral body, which coincides with the central axis of the fastener in the implanted state.
  • the amount of the gradient of the bending stiffness can be at least twice as large, in particular at least 5 times, at least in one region of the shaft so large, and more particularly at least 10 times as large as the lower shaft area.
  • the - viewed from the head - located behind the discharge zone lower shaft region is more rigid than the relief zone.
  • This embodiment of the fastener is not mandatory. In principle, it is also possible to provide an extending to the free end of the fastener relief zone. With a suitable design, in particular the tip of the fastening element, a "guiding effect" in the pedicle can thereby be used.
  • the fastener is deflected during introduction so to speak “automatically” correcting the relatively hard cortical outer layer; with a trained pedicle screw could thus be screwed "around the corner", so to speak.
  • the change of the flexural rigidity from the relief zone to the lower shaft region can essentially occur abruptly.
  • the profile of the flexural stiffness curve between the upper shaft region and the lower shaft region may be substantially pot-shaped, trough-shaped or trough-shaped.
  • the position as well as the axial length of the relief zone in the shaft are based on the position of the transition zone between pedicle and vertebral body in the vertebra matched, for which the fastener is designed. Since the bone structure of vertebrae is well known, it is sufficiently clear at which point along the implanted shaft the aforementioned transition zone and the above-mentioned toggle point are. This applies at least in each case based on a specific, selected by the surgeon setting technique. For example, it should be noted that comparatively long pedicle screws are used, for example, for so-called bicortical anchoring. against this background, in the case of the pedicle screw specified here, the relief zone may be located in a middle region of the longitudinal extent of the shaft, in particular substantially in the two middle quarters of the shaft or in the middle third of the shaft.
  • the relief zone may occupy a significant axial length of the shaft. If the stem is threaded, then the relief zone may extend longitudinally through a plurality of threads.
  • the upper shaft region and the relief zone may be dimensioned such that in the implanted state, the relief zone is in the region of the transition between pedicle and vertebral body and in particular extends axially on both sides beyond the transition region, in one embodiment from the top, a rear transition portion of the relief zone has a greater axial length than a located before the transition section of the relief zone.
  • the shank may be threaded, with the thread being interrupted by the relief zone.
  • the shank can be made hollow at least in regions and in particular be provided with a central longitudinal bore.
  • the longitudinal bore may be continuous, but this is not mandatory.
  • One of the advantages of a through bore is that the fastening element can be guided during implantation, for example, by means of a Kirschner wire.
  • the shaft can also be made solid, wherein a solid version of the shaft can also be provided in the relief zone.
  • the shank can be provided with a cross-sectional weakening, at least in the relief zone, in comparison to the upper shank region and in particular also to a lower shank region.
  • the reduced bending stiffness in the relief zone of the shank can be realized by providing the shank in the relief zone with weakening due to material removal. This removal of material can take place in such a way that the moment of area of the shank is reduced with simultaneous optimum utilization of the material forming the shank.
  • the relief zone can be formed by an elongate shaft region with a reduced cross-sectional area compared to the upper shaft region and in particular also to a lower shaft region.
  • the shaft may be formed as a helix, at least in the relief zone.
  • the shaft can be provided, at least in the relief zone, with at least one groove-like or slit-like recess which, in particular, revolves in a helical fashion.
  • the circumferential recess can be oriented in the same direction or in opposite directions with respect to a thread formed on the shaft.
  • the shaft is hollow at least in regions, or provided with a central longitudinal bore, it can be provided that the wall of the shaft is perforated in the hollow shaft regions.
  • the wall can be broken in the threaded valley. But also possible is an embodiment in which the wall is interrupted in the thread crest.
  • Such a design of the shaft is also suitable for such fasteners that are not screwed into the vertebra, but rather be taken because due to the small slit width the impact pulses can be easily transferred in the axial direction.
  • the fastening element specified here does not necessarily have to be screws in the conventional sense, but may also be implantable fastening elements. Nevertheless, the shank of such an impact element can be provided with a threaded projection which does not hinder the impacting, but facilitates explantation by unscrewing.
  • the wall of the shaft may have at least in the relief zone two helically encircling slot-shaped openings.
  • the shaft can form a double helix at least in the region of the relief zone.
  • the pitch of the helix in the region of the relief zone can be at least 5 mm, in particular at least 10 mm.
  • the pitch of the helix may vary over the length of the shank, thereby varying the bending stiffness of the shank over the longitudinal extent.
  • a transverse bore is introduced into the shaft, through which the wire used for the erosion process is passed.
  • either the screw or the wire is advanced in the axial direction of the screw.
  • the screw is rotated about its longitudinal axis. This results in a helical slot or simultaneously two helically encircling slots are created. Without the rotation of the screw creates a straight slot.
  • the processing is carried out in particular to the clamping of the screw out or when clamping on both sides to the clamping point, via which the feed and / or torque is applied. This ensures good power transmission during the machining process.
  • the screw is clamped or driven on the head and the erosion process takes place towards the head.
  • the shaft may be provided at least in the relief zone with transverse or perpendicular to the shaft axis extending transverse bores.
  • the shaft can be provided with a plurality of slots, groove or notch-like depressions arranged one after the other in the axial direction and in particular offset.
  • the depth of the depressions is greater than the half diameter of the shaft measured in the region of the depression.
  • the bending stiffness profile of the shank may be identical in all the planes containing the central axis of the shank, i. a rotational symmetry of the bending stiffness profile - relative to the central axis of the shaft - is not mandatory. Consequently, the bending stiffness profile of the shank may be rotationally asymmetric relative to its longitudinal axis.
  • the relief zone may be configured such that flexural rigidity is least in a plane subtended by the longitudinal axis of the shaft and the direction of an intervertebral force applied over the head in the implanted state, wherein in one embodiment, the flexural rigidity is in a plane perpendicular thereto Level is the largest.
  • the shank in the region of the relief zone can have a rotationally asymmetric cross section, and, in particular in the plane of greatest bending stiffness, can have substantially the same dimension as the immediately adjacent upper and lower shank regions.
  • the shaft may have at least one slot penetrating the shaft and extending substantially in the longitudinal direction of the shaft in the relief zone.
  • a slotted portion of the shank may be called, as it were, a spiral of "infinitely" helical pitch, and thus represents a special case of a helical relief zone, and may also be manufactured by a wire erosion method without rotation of the screw, as described above.
  • the upper shank region may have at least one substantially longitudinal recess on the surface. In such wells, the bone can grow, creating an anti-rotation is created.
  • the shaft may be integrally formed.
  • the relief zone may be formed at least in part by an intermediate piece made of a material deviating from the rest of the shank material.
  • the intermediate piece may be made of a particular fiber-reinforced plastic material, in particular a polymer material.
  • Shank regions adjacent to the relief zone may be interconnected by a joint located in the relief zone.
  • the relief zone can be formed by a joint which connects two directly adjoining shank areas.
  • the production of the opening can be made such that when penetrating the thread crests of a thread provided in this area cutting edges are generated can facilitate a screwing the pedicle screw.
  • the preparation of a pedicle screw can be effected by a wire erosion process in which starting from an at least partially hollow shaft extending through the shaft extending wire relative to the pedicle screw is such that arise in the wall two helically encircling slot-shaped openings with a predetermined helix pitch.
  • the shank of the fastening element can have a circular cross section.
  • a circular cylindrical shape is not mandatory. Rather, it is possible for the shank to have a cross section deviating from a circular shape, for example an elliptical or oval cross section. As a result, the circumstance can be taken into account that pedicles do not have a circular cylindrical shape but an oval cross section.
  • a fastener with a correspondingly shaped shank can therefore better abut the cortical wall of the pedicle than a shank with a circular cylindrical shape, whereby an improved anchoring in the pedicle can be produced.
  • the shaft can be made of a memory metal, for example of a memory metal NiTi-based.
  • Intervertebral stabilization systems with fasteners to be anchored into the vertebral body through the pedicles, in particular pedicle screws, are known in principle. As already explained, it is fundamentally possible to distinguish between rigid or angle-stable systems or systems with angle-invariant coupling on the one hand and dynamic or elastic systems or systems with angle-variant coupling on the other hand.
  • a dynamic intervertebral stabilization system is marketed by the assignee under the product name "Dynesys" and is incorporated herein by reference EP 669 109 described.
  • connection device For example, comprise a rigid or elastic rod with which at least two fasteners or pedicle screws are rigidly connected together.
  • the connecting device may comprise a train-pretensionable band, which in the implanted state is surrounded by at least one compressible pressure body arranged between two adjacent pedicle screws ("Dynesys").
  • intervertebral stabilization systems Basically in all intervertebral stabilization systems, the pedicle screws specified here can now be provided. Since intervertebral stabilization systems are basically known per se, these systems will not be discussed in more detail below.
  • the fasteners described below are designed for a dynamic or elastic intervertebral stabilization system, for example, for the Applicant's Dynesys system, as already explained above (see also Fig. 17 with accompanying explanation at the end of the description).
  • Fasteners such as pedicle screws for intervertebral stabilization systems vary particularly in the region of the head, since the head is used for coupling with the connecting device, are connected by the fasteners or pedicle screws of adjacent vertebrae together.
  • the heads of the fasteners described below are designed for the Applicant's Dynesys system.
  • the design of the shank of the individual fasteners can in principle be combined with any desired designed heads and is therefore basically used for any intervertebral stabilization systems.
  • the Fig. 1 and 2 show a trained for the Applicant's Dynesys system, belonging to the prior art pedicle screw.
  • the shaft 12 having a circular cross-section is provided with a thread 31 and is conical.
  • the head 11 is provided on two opposite sides with holding troughs 51, which serve during implantation for holding the screw by means of a correspondingly formed instrument. On the other two opposite sides of the head 11 is flattened.
  • the flat support surfaces 45 formed thereby serve to support not shown, cylindrical compressible pressure bodies of the stabilization system.
  • a pretensionable on train band of the stabilization system is guided through this elastic pressure body and through a formed in the head 11 passage 47 and fixed by means of a fixing screw, not shown, which is screwed into a formed in the head 11 thread 49 on the head 11.
  • the band is biased to train, while the arranged between two screw heads 11 and is pressed against the support surfaces 45 elastic pressure body is compressed.
  • a dynamic, on both compressive and tensile loads perpendicular to the screw axis elastically reacting stabilizing system is realized.
  • Fig. 2 schematically shows such a known pedicle screw, which is implanted in a vertebra and in this case extends with its shaft 12 through the pedicle 13 through into the vertebral body 15.
  • rigid pedicle screws under the action of an intervertebral force F applied via the head 11 tend to tilt or rotate about a so-called toggle point or fulcrum 53, which, as studies have shown, lies in the transitional region 23 between the pedicle 13 and the vertebral body 15 ,
  • the dimensions to be used in a particular case depend, inter alia, on the technique used to position the pedicle screws.
  • the bending stiffness C measured in the direction of the longitudinal axis of the implanted fastening element can be defined as the product of modulus of elasticity and second order moment of area (area moment of inertia).
  • the flexural stiffness profile of the fastener is particularly well suited to show the difference between conventional rigid pedicle screws on the one hand and the flexible fasteners specified here on the other hand.
  • the bending stiffness of the fastener can be influenced by the choice of material for the shaft and the shaft geometry. In the first case, the modulus of elasticity is varied, whereas in the second case the moment of area is changed.
  • Fig. 3 shows in the lower third of a fastener, which is provided in the form of a pedicle screw and a head 11 and a shaft 12 has.
  • the shaft 12 is provided with a relief zone 17 (zone II). Details of this relief zone 17 will not be discussed at this point. Concrete embodiments are explained below.
  • Fig. 3 serves to explain general relationships.
  • bending stiffness profiles are shown for differently shaped fasteners.
  • the middle third of the Fig. 3 shows the flexural stiffness profile of the bone structure in which the pedicle screw is implanted, ie the bone structure of pedicle 13 and vertebral body 15.
  • the flexural stiffness profiles shown are along measured the central axis of the shaft 12 of the fastener, which coincides at least approximately with the central axis of the pedicle 13.
  • the presentation of the Fig. 3 is divided into three zones along the shaft 12.
  • the shaft region between the head 11 and the beginning of the relief zone 17 is also referred to as the upper shaft region 19 (zone I), while the region of the shaft 12 located behind the relief zone 17 as viewed from the head 11 also acts as the lower shaft region 21 (zone III ) referred to as.
  • Curve 1 shows the flexural stiffness profile of a conventional, assumed as ideal cylindrical rigid pedicle screw without relief zone.
  • the flexural rigidity C is constant over the entire shaft length.
  • Curve 2 shows the bending stiffness profile of a tapered conical pedicle screw or a pedicle screw with a conical core in the direction of the free shaft end.
  • the flexural rigidity steadily decreases in this case.
  • Curves 3, 3a, 3b and 3c show flexural stiffness profiles of fasteners each provided with a relief zone or region 17.
  • the relief zone 17 begins before the transition between the pedicle 13 and the vertebral body 15 and ends behind this transition within the vertebral body 15.
  • the bending stiffness profile in each case has a pot-like course with steep walls, ie the decrease or increase in the flexural rigidity occurs abruptly.
  • the transitions can be pronounced more or less stepped be.
  • the dotted curve shows an example in which the transitions are rounded off from the course shown by the solid line.
  • the curves 3a and 3b show flexural stiffness profiles respectively corresponding to the course of the curve 3, with the difference that the lower shaft region 21 (zone III) is provided with significantly reduced rigidity, but still significantly above that in the relief zone 17 (zone II) is located.
  • the flexural rigidity in the lower shaft portion 21 corresponds to that in the relief zone 17.
  • the relief zone 17 extends to the tip at the free end of the fastener.
  • the upper third of the Fig. 3 Figure 12 also shows that the flexural stiffness CF in the relief zone 17 (zone II) is only about one-tenth of the corresponding value CS in the upper shaft region 19 (zone I).
  • curve 7 shows the axial course of the elastic modulus of the bone structure of pedicle 13 and vertebral body 15.
  • the corresponding course of the second-order surface moment of the bone is shown in curve 8.
  • the sum of the two curves 7 and 8, which represents the profile of the bending stiffness C of the bone structure of pedicle 13 and vertebral body 15 in this simplified model, is shown by a solid line as curve 6.
  • the flexural rigidity of the vertebra is greatest in the region of the transition between pedicle 13 and vertebral body 15.
  • the comparison with the upper third of the Fig. 3 shows that the relief zone 17 may be positioned in the shaft 12 such that with implanted fastener corresponding to the lower third of the Fig. 3 the transition between pedicle 13 and vertebral body 15 and thus the area of maximum bending stiffness of the vertebra within the relief zone 17 of the shaft 12 and in particular - viewed in the axial direction - is located centrally in the relief zone 17.
  • the length of the zone II ie the relief zone or flexible transition zone 17 a range of 0 mm to 35 mm may be provided.
  • the smallest length may be present when the relief zone 17 is designed as a joint (see the following embodiment in Fig. 13 ). In this case, the relief zone 17 is formed practically from the rotation axis of the joint. The greatest length may be present when the Relief zone 17 extends to the top of the fastener.
  • a range of 0 mm to 35 mm may be provided. The smallest length is given if no lower shaft portion 21 in the sense of Fig. 3 is provided, but extends the relief zone 17 to the top of the relief element. The greatest length may be present when the free end of the fastener touches or even penetrates the anterior cortex (so-called bicortical screw insertion technique).
  • the relief zone 17 is formed by material removal on the shaft. Consequently, the relief zone 17 here is a shank region 27 with a reduced cross-sectional area compared to the adjacent shank regions 19, 21.
  • the cross section in the relief zone 17 is not circular, but the shaft portion 27 is formed like a leaf spring and provided in the form of a thin strip. The width of the strip corresponds to the original shaft diameter, whereas the strip thickness is substantially smaller than the original shaft diameter.
  • the bending stiffness profile of the shaft is thus rotationally asymmetric relative to its longitudinal axis.
  • the orientation of the relief zone 17 is selected such that the plane defined by the strip 27 extends parallel to the flat support surfaces 45 on the screw head 11.
  • the relief zone 17 is therefore fully effective only in one plane, this plane is spanned by the longitudinal axis of the shaft and a normal of the flat support surfaces 45.
  • This calculation example - which therefore does not lead to an optimal fastening element, but is nevertheless suitable for explaining the basic principle of the pedicle screw specified here - thus shows that the relief zone on the one hand determines the load capacity of the fastener and on the other hand, the load on the vertebral body:
  • the flexural rigidity in be reduced to the extent that the load capacity of the vertebral body is not exceeded, because the more resistant the relief zone is executed, the larger forces or moments can be transmitted to the vertebral body, which is basically desirable, because the free end of the fastener should contribute maximum, just without overloading the vertebral body (and so cause a relaxation).
  • the fastener is thus designed so that there is an optimal "compromise" between these two basically opposing optimization criteria.
  • Fig. 5 is different from the one in Fig. 4 illustrated embodiment of the relief zone 17 forming shaft portion 27 is provided with a circular cross-section.
  • the bending stiffness profile of the screw is thus rotationally symmetric with respect to its longitudinal axis.
  • the relief region 17 forming shaft portion is not made in one piece, but is formed by a separate intermediate piece 33 which is anchored in the upper and lower shaft portions 19, 21.
  • the intermediate piece 33 can be a rod made of a material of particularly low bending stiffness ("super-elastic" material). In particular, it is a material that can be deformed up to 10% or more without permanent deformation, which is not achieved by the usual implant steels or titanium.
  • a memory metal NiTi-based eg Nitinol
  • FIG. 6 Another example of such a reduction in modulus of elasticity by material change is shown Fig. 6 , Unlike the example in the lower illustration in Fig. 5 no cross-section reduction takes place here, but only a material change.
  • the material used for the pedicle screw specified here, and thus for the lower and upper shaft regions 19, 21 and the screw head 11, is in particular a biocompatible titanium or steel alloy.
  • a material is used which has a significantly lower modulus of elasticity than the shaft material and thus provides for a corresponding flexibility or flexibility of the shaft.
  • One possible material for the intermediate piece 33 is plastic, in particular an elastomer.
  • the plastic can be fiber reinforced.
  • Fig. 7 shows a variant in which also an example made of plastic material intermediate piece 33 is provided to form the relief zone 17.
  • the anchoring to the adjacent shaft portions 19, 21 takes place by integrally formed on these shank portions 19, 21 axial extensions 19a, 21a, which are provided to improve the positive engagement with radial broadening.
  • a special feature of this variant is that the extensions 19a, 21a approximately in the middle of the relief zone 17 within the intermediate piece 33 cooperate like a hinge, in the example shown here according to the ball / shell principle, where, for example, a hinge assembly may be provided.
  • the upper shaft portion 19 and the lower shaft portion 21 are thus connected in this example by a hinge 35 which is surrounded by the elastic material of the intermediate piece 33, whereby in the case of a deflection of the shaft for the corresponding restoring forces is provided.
  • the joint area forming the relief zone 17 can be extrusion-coated, in particular with the material forming the intermediate piece 33.
  • Fig. 8 . 9 and 10 show embodiments in which in turn reduces the momentum and while the shaft material is optimally utilized.
  • the shaft is provided with a central bore 25.
  • This is advantageous in terms of manufacturing technology and also makes it possible to implant the pedicle screws with the aid of a Kirschner wire, which is advantageous in particular in the case of percutaneous implantation.
  • the thread 31 of the screw is designed to be continuous.
  • the wall of the shaft is broken in the threaded valley.
  • the shaft is formed in the region of the relief zone 17 in the manner of a coil spring or a corkscrew.
  • Such a relief zone can easily be manufactured, for example, by wire erosion or by a driven side milling cutter.
  • the circumferential in the relief zone in the threaded valley slot can have a significantly smaller slot width than in Fig. 8 shown.
  • the slot width can be chosen so small that at a certain deflection of the shaft, the turns in the relief zone abut each other or rest, so that in this way pressure forces can be transmitted.
  • the slots can be filled with a bioresorbable substance, which reduces or eliminates the spring effect.
  • the intraoperative stability of the shaft can be increased.
  • the absorption takes place comparatively quickly or within a few days. Subsequent to the absorption, the flexibility of the screw predetermined by the shaft geometry is then fully effective.
  • a central through hole as in the example of Fig. 8 , is not mandatory. Like the example of Fig. 9 shows, may also be provided only partially through the shaft extending through central bore 25. In this example, the bore 25 ends in the region of the lower shaft portion 21.
  • Fig. 10 shows, it is also possible for shafts without central bore, spiral or helical circumferential recesses provided to form the relief zone 17.
  • a spiral can also be formed in this case Structures are made, thus making a central hole superfluous.
  • the orientation of the depressions or slots can in this case according to the examples of Fig. 8 and 9 be elected either equal or opposite in relation to the screw thread 31.
  • Fig. 11 includes several features, which are explained below, wherein such a combination of features is not mandatory, but the individual aspects can also be realized independently of each other in conjunction with other embodiments.
  • the shaft is provided with staggered slots 41 of small width, each opening into a through bore 39. Due to the small slot width, the impact pulses required for driving can be easily transmitted in the axial direction.
  • the cross-section of the shank may deviate from a circular shape and be designed in particular oval or elliptical in order to achieve a better adaptation to the natural pedicle shape, as has already been explained in the introduction.
  • shank of the fastening pin to be hammered can be provided with a thread present in the neck in order to be used in the case a re-operation to facilitate the explantation of the fastener.
  • Fig. 12 shows an example with staggered arranged relief slots or notches 43, whose width is greater in each case than that of the slots 41 in the example of Fig. 11 ,
  • Such relief grooves can be provided both in shafts with circular and with a deviating from a circular cross-section.
  • a hinge 37 may be provided between the upper shaft portion 19 and the lower shaft portion 21.
  • a hinge pin defining the axis of rotation 38 of the joint 37 extends parallel to the planar support surfaces 45 of the screw head 11. The position of the joint 37 along the shaft axis can be placed so that the axis of rotation of the joint 37 at implanted screw in the range of the aforementioned toggle point ( Fig. 3 ) and in particular runs through the toggle point.
  • the relief zone such that its flexural rigidity increases over time.
  • a plastic material can be used for the relief zone, the hardness of which increases over time, whereby the force or torque transmission increases correspondingly to the free end region of the fastener. This can take into account the fact that, after a certain time following the operation, it can be assumed that the fastening element has grown well into the bone material.
  • the initially relatively high flexibility of the shaft thus serves in particular the purpose of avoiding high loads shortly after the operation.
  • the shaft are formed such that the flexural rigidity in the relief zone decreases over time.
  • absorbable components may be provided which have a stiffening effect during implantation and are absorbed over time, which gradually increases the flexibility of the shaft in the relief zone.
  • Fig. 14 shows a pedicle screw whose shaft 12 for forming the relief zone 17 has a shaft 12 penetrating and extending in the longitudinal direction of the shaft 12 slot 65.
  • Fig. 15 is the example of the pedicle screw of Fig. 14 shown that the upper shaft portion 19 may have longitudinally extending recesses 66 on the surface into which the bone can grow, thereby providing an anti-rotation.
  • Fig. 16 are shown purely schematically - several possible embodiments of the head 11 of a fastener of the type specified here, which differ by how a connecting element 64 of an intervertebral stabilization system - for example, a belt 64 in the Dynesys system of the applicant (see also the description below Fig. 17 ) - can be recorded in or on the head 11.
  • a connecting element 64 of an intervertebral stabilization system for example, a belt 64 in the Dynesys system of the applicant (see also the description below Fig. 17 ) - can be recorded in or on the head 11.
  • the head 11 While in the upper embodiment of the head 11 is formed as a ring or eyelet through which the connecting element 64 is passed, in the other embodiments, the head 11 in the manner of - with respect to the longitudinal axis of the fastener - upright, inclined or executed on the side "U", so that the connecting element 64 does not need to be “threaded through” through an opening, but (in the direction of arrow) can be inserted, either from above (so-called “toploading” principle) or from the side (so-called “sideloading” principle). All above, in particular with reference to Fig. 3 to 15 described embodiments of the pedicle screw specified here can in principle with each of the in Fig. 16 shown head variants are provided.
  • the "toploading" principle is for example in EP 528 706 described.
  • Fig. 17 shows in several representations an example of an intervertebral stabilization system, which may include fasteners specified herein, in particular in the form of pedicle screws.
  • the dynamic system shown is an elastic support system (Applicant's Dynesys system), as previously mentioned several times.
  • Neighboring vortices are interconnected by two identical subsystems.
  • two pedicle screws each having a shaft 12 and a head 11 are implanted, each extending through a pedicle 13 into the vertebral body 15.
  • a compressible pressure or support body 63 is arranged in each case between two screw heads 11.
  • a in the implanted state to train biased and fixed by means of fixing screws 61 in the heads 11 band 64 extends through the pressure body 63 and the heads 11 therethrough. With the belt 64 tensile forces and the pressure body compressive forces are absorbed elastically.
  • the pedicle screws shown may be fasteners of the type specified herein.

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  • Health & Medical Sciences (AREA)
  • Orthopedic Medicine & Surgery (AREA)
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Claims (39)

  1. Vis pédiculaire, comportant
    une tête (11) destinée à l'accouplement avec un système de stabilisation ou de soutien intervertébral élastique, dans laquelle la tête (11) est réalisée sous la forme d'un oeillet fermé ou ouvert sur un côté qui est prévu pour recevoir un système de stabilisation ou de soutien intervertébral, en particulier un barreau ou un ruban, et une tige qui sert à l'ancrage dans une vertèbre et qui, dans l'état implanté, s'étend à travers le pédicule (13) jusque dans le corps vertébral (15),
    caractérisée en ce que
    la tige comprend, vue dans son extension longitudinale mesurée depuis la tête (11) :
    une zone de tige (19) supérieure adjacente à la tête (11) et une zone de décharge (17) qui se raccorde à la zone de tige supérieure (19),
    dans laquelle
    la zone de décharge (17) présente une rigidité réduite à la flexion par rapport à la zone de tige supérieure (19),
    la zone de décharge (17) est située dans la région de la tige prévue pour l'agencement dans l'os, et
    la zone de décharge (17) est située entre la zone de tige supérieure (19) et une zone de tige inférieure (21) qui présentent toutes les deux une rigidité à la flexion plus élevée que celle de la zone de décharge (17).
  2. Vis pédiculaire selon la revendication 1,
    caractérisée en ce que
    la tête (11) est accouplée rigidement, en particulier d'un seul tenant, à la zone de tige supérieure (19) au moins en direction de flexion de la tige.
  3. Vis pédiculaire selon la revendication 1 ou 2,
    caractérisée en ce que
    à la transition de la zone de tige supérieure (19) vers la zone de décharge (17), le gradient de la rigidité à la flexion est d'une valeur supérieure, en particulier significativement supérieure à un gradient de rigidité à la flexion qui se présente dans la zone de tige supérieure (19).
  4. Vis pédiculaire selon la revendication 3,
    caractérisée en ce que
    à la transition de la zone de tige supérieure (19) vers la zone de décharge (17), au moins dans une région de la tige, la valeur du gradient de la rigidité à la flexion est au moins deux fois plus élevée, de préférence au moins cinq fois plus élevée, et en outre en particulier au moins dix fois plus élevée que celle dans la zone de tige supérieure (19).
  5. Vis pédiculaire selon la revendication 3 ou 4,
    caractérisée en ce que
    au niveau de la transition, la rigidité à la flexion se réduit sensiblement par saut.
  6. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    dans la zone de décharge (17), dans au moins un plan de flexion, la rigidité à la flexion est inférieure d'au moins 30 %, en particulier d'au moins 50 %, selon un autre mode de réalisation d'au moins 60 %, et selon encore un autre mode de réalisation d'au moins 80 % par rapport à la rigidité à la flexion dans la zone de tige supérieure (19).
  7. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la zone de tige supérieure (19) est dimensionnée de telle sorte que la zone de décharge (19) est située dans la région de la tige prévue pour l'agencement dans le tissu spongieux, tandis qu'au moins la région prévue pour l'agencement de la corticale est formée par la zone de tige supérieure (19).
  8. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la longueur de la zone de tige supérieure (19) est au minimum de 5 mm, en particulier au minimum de 8 mm, et au maximum de 15 mm, en particulier au maximum de 12 mm.
  9. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    un profil axial de rigidité à la flexion de la tige est au moins approché à l'évolution qualitative de la rigidité à flexion du pédicule (13) et correspond à celle-ci, dans le cas idéal.
  10. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    à la transition de la zone de décharge (17) vers la zone de tige inférieure (21), dans une région au moins de la tige, la valeur du gradient de la rigidité à la flexion est au moins deux fois plus élevée, de préférence au moins cinq fois plus élevée, et en outre en particulier au moins dix fois plus élevée que celle dans la zone de tige inférieure (21).
  11. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    le changement de la rigidité à la flexion depuis la zone de décharge (17) vers la zone de tige inférieure (21) se réduit sensiblement par saut.
  12. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    le profil de l'évolution de la rigidité à la flexion entre la zone de tige supérieure (19) et la zone de tige inférieure (21) est réalisé sensiblement en forme de pot, d'auge ou de cuve.
  13. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la zone de décharge (17) est située dans une région médiane de l'extension longitudinale de la tige, en particulier sensiblement dans les deux quarts médians de la tige ou dans le tiers médian de la tige.
  14. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la zone de tige supérieure (19) et la zone de décharge (17) sont dimensionnées de telle sorte que dans l'état implanté, la zone de décharge (17) se trouve au niveau de la transition entre le pédicule (13) et le corps vertébral (15) et s'étend en particulier de part et d'autre axialement au-delà de la zone de transition (23), et dans un mode de réalisation, vu depuis la tête (11), une partie de la zone de décharge (17) située derrière la transition présente une longueur axiale supérieure à celle d'une partie de la zone de décharge (17) située en avant de la transition.
  15. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la tige est pourvue d'un pas de vis (31), le pas de vis (31) étant interrompu par la zone de décharge (17).
  16. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la tige est réalisée creuse au moins localement et est en particulier pourvue d'un perçage longitudinal central (25).
  17. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    au moins dans la zone de décharge (17) la tige est pourvue d'un affaiblissement de section transversale (29, 39, 43, 65) par comparaison à la zone de tige supérieure (19) et en particulier également par comparaison à une zone de tige inférieure (21).
  18. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la zone de décharge (17) est formée par une zone de tige allongée (27) ayant une aire de section réduite par comparaison à la zone de tige supérieure (19) et en particulier également par comparaison à une zone de tige inférieure (21).
  19. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la tige est réalisée sous forme d'hélice au moins dans la zone de décharge (17).
  20. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    au moins dans la zone de décharge (17), la tige est pourvue d'au moins un renfoncement (29) en forme de gorge ou de fente qui s'étend en particulier en hélice.
  21. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    au moins dans la zone de décharge (17), la paroi de la tige présente deux traversées en forme de fente s'étendant en hélice.
  22. Vis pédiculaire selon la revendication 21,
    caractérisée en ce que
    la tige réalise une hélice double au moins dans la région de la zone de décharge (17).
  23. Vis pédiculaire selon l'une des revendications 19 à 22,
    caractérisée en ce que
    le pas de l'hélice dans la région de la zone de décharge (17) est d'au moins 5 mm, en particulier d'au moins 10 mm.
  24. Vis pédiculaire selon l'une des revendications 19 à 23,
    caractérisée en ce que
    le pas de l'hélice varie sur l'extension longitudinale de la tige, ce pourquoi la rigidité de la tige à la flexion varie sur l'extension longitudinale.
  25. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    au moins dans la zone de décharge (17) la tige est pourvue de perçages transversaux (39) qui s'étendent perpendiculairement ou en oblique par rapport à l'axe de la tige.
  26. Vis pédiculaire selon la revendication 25,
    caractérisée en ce que
    il est prévu des fentes (41) qui mènent de la paroi extérieure de la tige jusqu'aux perçages transversaux (39) et dont la largeur est inférieure au diamètre des perçages transversaux (39).
  27. Vis pédiculaire selon l'une des revendications 1 à 18 ou 25 à 26,
    caractérisée en ce que
    la tige est pourvue de plusieurs renfoncements (43) en forme de fente, de gorge ou d'encoche, disposés les uns derrière les autres en direction axiale et en particulier en décalage, et selon un mode de réalisation la profondeur respective des renfoncements (43) est supérieure à la moitié du diamètre de la tige mesuré dans la région du renfoncement (43).
  28. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    le profil de la rigidité à la flexion de la tige par rapport à son axe longitudinal n'est pas à symétrie de révolution.
  29. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la zone de décharge (17) est réalisée de telle sorte que la rigidité à la flexion est la plus faible dans un plan qui est tendu de l'axe longitudinal de la tige et dans la direction d'une force intervertébrale appliquée par la tête (11) dans l'état implanté, et selon un mode de réalisation la rigidité à la flexion est la plus élevée dans un plan tendu perpendiculairement à celui-ci.
  30. Vis pédiculaire selon la revendication 28 ou 29,
    caractérisée en ce que
    dans la région de la zone de décharge (17), la tige présente une section qui n'est pas à symétrie de révolution et présente, en particulier dans le plan de la plus grande rigidité à la flexion, une dimension sensiblement identique à celle des zones de tige (19, 21) supérieure et inférieure, directement adjacentes.
  31. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    dans la zone de décharge (17) la tige présente au moins une fente (65) qui traverse la tige et qui s'étend sensiblement en direction longitudinale de la tige.
  32. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la zone de tige supérieure (19) comprend au moins un renfoncement (66) sur la surface, qui s'étend sensiblement en direction longitudinale.
  33. Vis pédiculaire selon l'une des revendications précédentes,
    caractérisée en ce que
    la tige est réalisée d'un seul tenant.
  34. Vis pédiculaire selon l'une des revendications 1 à 32,
    caractérisée en ce que
    la zone de décharge (17) est formée au moins en partie par un élément intermédiaire (33) en un matériau qui se distingue du matériau restant de la tige.
  35. Vis pédiculaire selon la revendication 34,
    caractérisée en ce que
    l'élément intermédiaire (33) est réalisé en une matière plastique en particulier renforcée par des fibres, en particulier en un matériau de polymère.
  36. Vis pédiculaire selon l'une des revendications 1 à 32 ou 34 à 35,
    caractérisée en ce que
    des zones de tige (19, 21) adjacentes à la zone de décharge (17) sont reliées entre elles par une articulation (35) située dans la zone de décharge (17).
  37. Vis pédiculaire selon l'une des revendications 1 à 32 ou 34 à 35,
    caractérisée en ce que
    la zone de décharge (17) est formée par une articulation (37) qui relie entre elles deux zones de tige (19, 21) directement adjacentes.
  38. Système de stabilisation intervertébral comportant une pluralité de vis pédiculaires selon l'une des revendications précédentes, aptes à être ancrées sur les vertèbres (13, 15), et comportant un dispositif de liaison pour relier au moins deux vis pédiculaires ancrées sur des vertèbres voisines (13, 15) pour former un système élastique de rigidification ou de soutien.
  39. Système de stabilisation intervertébral selon la revendication 38,
    caractérisé en ce que
    pour former un système élastique de soutien, le dispositif de liaison comprend un ruban susceptible d'être précontraint en traction qui, dans l'état implanté, est entouré par au moins un corps compressible agencé entre deux vis pédiculaires voisines.
EP06724014.3A 2005-04-04 2006-04-04 Vis pédiculaire Expired - Lifetime EP1865862B1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP06724014.3A EP1865862B1 (fr) 2005-04-04 2006-04-04 Vis pédiculaire

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
EP05007292 2005-04-04
EP06724014.3A EP1865862B1 (fr) 2005-04-04 2006-04-04 Vis pédiculaire
PCT/EP2006/003059 WO2006105935A1 (fr) 2005-04-04 2006-04-04 Vis pédiculaire

Publications (2)

Publication Number Publication Date
EP1865862A1 EP1865862A1 (fr) 2007-12-19
EP1865862B1 true EP1865862B1 (fr) 2016-08-24

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
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Country Status (4)

Country Link
US (1) US20090062868A1 (fr)
EP (1) EP1865862B1 (fr)
JP (1) JP4964226B2 (fr)
WO (1) WO2006105935A1 (fr)

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US8043337B2 (en) 2006-06-14 2011-10-25 Spartek Medical, Inc. Implant system and method to treat degenerative disorders of the spine
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EP1865862A1 (fr) 2007-12-19
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JP2008534096A (ja) 2008-08-28
US20090062868A1 (en) 2009-03-05

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